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Hilditch C, Rumbold AR, Keir A, Middleton P, Gomersall J. Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews. Neonatology 2024:1-10. [PMID: 38513630 DOI: 10.1159/000536660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION This overview aims to systematically review evidence regarding effects of interventions undertaken in neonatal units to increase breastfeeding in preterm infants. METHODS We followed Cochrane methodology. Systematic reviews published to October 31, 2022, reporting meta-analysis of effects from original studies on breastfeeding rates in preterm infants of neonatal unit interventions designed to increase breastfeeding were included. RESULTS Avoidance of bottles during breastfeed establishment (comparator breastfeeds with bottle-feeds) demonstrated clear evidence of benefit for any breastfeeding at discharge and exclusive breastfeeding 3 months post-discharge, and possible evidence of benefit for exclusive breastfeeding at discharge, and any breastfeeding post-discharge. Kangaroo mother care (KMC) (comparator usual care) demonstrated clear evidence of benefit for any and exclusive breastfeeding at discharge and possible benefit for any breastfeeding post-discharge. Quality improvement (QI) bundle(s) to enable breastfeeds (comparator conventional care) showed possible evidence of benefit for any breastfeeding at discharge. Cup feeding (comparator other supplemental enteral feeding forms) demonstrated possible evidence of benefit for exclusive breastfeeding at discharge and any breastfeeding 3 months after. Early onset KMC (commenced <24 h post-birth), oral stimulation, and oropharyngeal colostrum administration, showed no evidence of benefit. No meta-analyses reported pooled effects for gestational age or birthweight subgroups. CONCLUSION There is ample evidence to support investment in KMC, avoidance of bottles during breastfeed establishment, cup feeding, and QI bundles targeted at better supporting breastfeeding in neonatal units to increase prevalence of breastfeeding in preterm infants and promote equal access to breastmilk. Stratifying effects by relevant subgroups is a research priority.
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Affiliation(s)
- Cathie Hilditch
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Alice R Rumbold
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
| | - Judith Gomersall
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Quitadamo PA, Zambianco F, Palumbo G, Wagner X, Gentile MA, Mondelli A. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review. Foods 2024; 13:649. [PMID: 38472762 DOI: 10.3390/foods13050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 03/14/2024] Open
Abstract
Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milan, MI, Italy
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Xavier Wagner
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Université Paris Cité, 79279 Paris, France
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
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Lamport L, Weinberger B, Maffei D. Human Milk Fortifier After Neonatal Intensive Care Unit Discharge Improves Human Milk Usage Rates for Preterm Infants. J Nutr 2024; 154:610-616. [PMID: 38072151 DOI: 10.1016/j.tjnut.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND A common neonatal intensive care unit (NICU) discharge feeding strategy for preterm infants with growth failure who are fed exclusively expressed human milk (EHM) has been to enrich mother's own milk with formula powder or supplement 2-3 feeds per day with formula. However, this strategy displaces human milk from the diet. Our NICU recently adopted the standard practice of adding commercial human milk fortifier (HMF) to human milk feedings after discharge. OBJECTIVES We aimed to compare breastfeeding rates and growth using the aforementioned 2 strategies. METHODS Preterm infants (<34 wk of gestation at birth) exclusively feeding EHM fortified with HMF at 2 weeks before discharge were included in this retrospective study. The HMF group (n = 92) continued fortifying with HMF at home, whereas the historical comparison group (n = 35) received our previous guidance to enrich or supplement using postdischarge formula. RESULTS Rates of human milk exclusivity after discharge decreased significantly less in the HMF group than those in the historical comparison group (to 83% compared with 39% at the first outpatient visit and 27% compared with 6%, respectively, at the second outpatient visit). Rates of any EHM feedings were also significantly higher in the HMF group. Fenton z-scores for weight, length, and head circumference were not significantly different between the groups. CONCLUSIONS Continuing EHM fortification with HMF after NICU discharge, rather than enriching or supplementing with postdischarge infant formula, increases rates of feeding EHM for ≥3 mo but does not affect growth.
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Affiliation(s)
- Lyssa Lamport
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Barry Weinberger
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Diana Maffei
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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Wohlers L, Maier RF, Cuttini M, Wilson E, Benhammou V, Lebeer J, Laroche S, Sarrechia I, Petrou S, Thiele N, Zeitlin J, Aubert AM. Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and Influencing Factors in a European Cohort. CHILDREN (BASEL, SWITZERLAND) 2023; 11:61. [PMID: 38255374 PMCID: PMC10814990 DOI: 10.3390/children11010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
(1) Background: Mothers of very preterm (VPT) infants may experience psychological symptoms compromising long-term emotional wellbeing. This study describes the emotional wellbeing of mothers of five-year-old children born VPT. We assess the association between sociodemographic, perinatal and neonatal characteristics, and the child's health and development at five years old and maternal emotional wellbeing. (2) Methods: Data are from the prospective European "Effective Perinatal Intensive Care in Europe" (EPICE) and subsequent "Screening for Health In very Preterm infantS in Europe" (SHIPS) projects including births <32 weeks' gestational age in 11 countries in 2011/12. Data were abstracted from obstetric and neonatal records. At five years old, 2605 mothers answered a parental questionnaire including the Mental Health Inventory-5 (MHI-5). Associations between sociodemographic and health characteristics and the mother's MHI-5 score were investigated using multilevel multivariate linear regression analysis with the country modelled as a random effect and inverse probability weighting to correct for attrition bias. (3) Results: The mean MHI-5 score was 71.3 (SD 16.7) out of 100 (highest emotional wellbeing) with a variation among countries from 63.5 (SD 16.8; Poland) to 82.3 (SD 15.8; the Netherlands). MHI-5 scores were significantly lower for mothers whose child had a severe health problem, developmental, or speech delay, for multiparous and single mothers, and when at least one of the parents was unemployed. (4) Conclusions: The emotional wellbeing of mothers of VPT infants differs between European countries. Identifying sociodemographic characteristics and child's health and developmental conditions that affect maternal emotional wellbeing may help to identify groups of mothers who need special assistance to cope with consequences of the delivery of a VPT child.
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Affiliation(s)
- Lena Wohlers
- Physiotherapy School, University Hospital of the Universities of Giessen and Marburg (UKGM), 35392 Giessen, Germany;
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, 35033 Marburg, Germany;
| | - Marina Cuttini
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS “Eugenio Medea”, 23842 Lecco, Italy;
| | - Emilija Wilson
- Unit of Reproductive Health, Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Valérie Benhammou
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
| | - Jo Lebeer
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.L.); (I.S.)
| | - Sabine Laroche
- Neonatal Intensive Care Unit, University Hospital Antwerp, 2610 Antwerp, Belgium;
- Center for Developmental Disabilities, University Hospital Antwerp, 2610 Antwerp, Belgium
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.L.); (I.S.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK;
| | - Nicole Thiele
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany;
| | - Jennifer Zeitlin
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
| | - Adrien M. Aubert
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
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El Rafei R, Maier RF, Jarreau PH, Norman M, Barros H, Van Reempts P, Van Heijst A, Pedersen P, Cuttini M, Johnson S, Costa R, Zemlin M, Draper ES, Zeitlin J. Postnatal growth restriction and neurodevelopment at 5 years of age: a European extremely preterm birth cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:492-498. [PMID: 36868809 DOI: 10.1136/archdischild-2022-324988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To investigate whether extrauterine growth restriction (EUGR) during the neonatal hospitalisation by sex among extremely preterm (EPT) infants is associated with cerebral palsy (CP) and cognitive and motor abilities at 5 years of age. STUDY DESIGN Population-based cohort of births <28 weeks of gestation with data from obstetric and neonatal records and parental questionnaires and clinical assessments at 5 years of age. SETTING 11 European countries. PATIENTS 957 EPT infants born in 2011-2012. MAIN OUTCOMES EUGR at discharge from the neonatal unit was defined as (1) the difference between Z-scores at birth and discharge with <-2 SD as severe, -2 to -1 SD as moderate using Fenton's growth charts (Fenton) and (2) average weight-gain velocity using Patel's formula in grams (g) per kilogram per day (Patel) with <11.2 g (first quartile) as severe, 11.2-12.5 g (median) as moderate. Five-year outcomes were: a CP diagnosis, intelligence quotient (IQ) using the Wechsler Preschool and Primary Scales of Intelligence tests and motor function using the Movement Assessment Battery for Children, second edition. RESULTS 40.1% and 33.9% children were classified as having moderate and severe EUGR, respectively, by Fenton and 23.8% and 26.3% by Patel. Among children without CP, those with severe EUGR had lower IQ than children without EUGR (-3.9 points, 95% Confidence Interval (CI)=-7.2 to -0.6 for Fenton and -5.0 points, 95% CI=-8.2 to -1.8 for Patel), with no interaction by sex. No significant associations were observed between motor function and CP. CONCLUSIONS Severe EUGR among EPT infants was associated with decreased IQ at 5 years of age.
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Affiliation(s)
- Rym El Rafei
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
- Sorbonne Université, Collège Doctoral, F-75005 Paris, France
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Pierre Henri Jarreau
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Patrick Van Reempts
- Laboratory of Experimental Medicine and Pediatrics, Division of Neonatology, Study Centre for Perinatal Epidemiology Flanders, University of Antwerp, Flanders, Brussels, Belgium
| | - Arno Van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen,the Netherlands/Erasmusmc, Rotterdam, The Netherlands
| | | | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Raquel Costa
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University, Saarland University Medical School, Homburg, Germany
| | | | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
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Caffarelli C, Gracci S, Giannì G, Bernardini R. Are Babies Born Preterm High-Risk Asthma Candidates? J Clin Med 2023; 12:5400. [PMID: 37629440 PMCID: PMC10455600 DOI: 10.3390/jcm12165400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Among preterm infants, the risk of developing asthma is a matter of debate. This review discusses the state of the art of poorly understood prematurity-associated asthma. Impaired pulmonary function is common in children born prematurely. Preterm infants are prone to developing viral respiratory tract infections, bronchiolitis in the first year of life, and recurrent viral wheezing in preschool age. All of these conditions may precede asthma development. We also discuss the role of both atopic sensitization and intestinal microbiome and, consequently, immune maturation. Diet and pollution have been considered to better understand how prematurity could be associated with asthma. Understanding the effect of factors involved in asthma onset may pave the way to improve the prediction of this asthma phenotype.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Serena Gracci
- Pediatric Unit, San Giuseppe Hospital, 50053 Empoli, Italy
| | - Giuliana Giannì
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Quitadamo PA, Zambianco F, Palumbo G, Copetti M, Gentile MA, Mondelli A. Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge. Nutrients 2023; 15:3314. [PMID: 37571252 PMCID: PMC10421341 DOI: 10.3390/nu15153314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milano, Italy;
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Statistical Department, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Mitha A, Pierrat V. Comment on "Trends and disparities in breastfeeding initiation in France between 2010 and 2016: Results from the French National Perinatal Surveys". MATERNAL & CHILD NUTRITION 2023; 19:e13494. [PMID: 36999241 DOI: 10.1111/mcn.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Ayoub Mitha
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics-Paris University, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
- Department of Emergency Medicine, CHU Lille, Pediatric and Neonatal Intensive Care Transport Unit, Lille, France
| | - Véronique Pierrat
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics-Paris University, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
- Department of Neonatal Medicine, CHICréteil, Créteil, France
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Oliver Olid A, Moreno-Galarraga L, Moreno-Villares JM, Bibiloni MDM, Martínez-González MÁ, de la O V, Fernandez-Montero A, Martín-Calvo N. Breastfeeding Is Associated with Higher Adherence to the Mediterranean Diet in a Spanish Population of Preschoolers: The SENDO Project. Nutrients 2023; 15:nu15051278. [PMID: 36904277 PMCID: PMC10005753 DOI: 10.3390/nu15051278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To assess whether breastfeeding during the first months of life is associated with adherence to the Mediterranean dietary (MedDiet) pattern in preschool children. DESIGN The Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project is an ongoing pediatric cohort with open recruitment, started in 2015 in Spain. Participants, recruited when they are 4 to 5 years old at their primary local health center or school, are followed annually through online questionnaires. For this study, 941 SENDO participants with full data on study variables were included. Breastfeeding history was collected retrospectively at baseline. Adherence to the Mediterranean diet was assessed with the KIDMED index (range -3 to 12). RESULTS After accounting for multiple sociodemographic and lifestyle confounders, including parental attitudes and knowledge about dietary recommendations for children, breastfeeding was independently associated with a higher adherence to the MedDiet. Compared with children who were never breastfed, children breastfed for ≥6 months had a one-point increase on their mean KIDMED score (Mean difference +0.93, 95%confidence interval [CI]. 0.52-1.34, p for trend <0.001). The odds ratio of high adherence to the MedDiet (KIDMED index ≥8) was 2.94 (95%CI 1.50-5.36) in children who were breastfed for at least 6 months, as compared to their peers who were never breastfeed. Children who were breastfed for less than 6 months exhibited intermediate levels of adherence (p for trend <0.01). CONCLUSION Breastfeeding for 6 months or longer is associated with a higher adherence to the Mediterranean diet during the preschool years.
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Affiliation(s)
- Asier Oliver Olid
- Department of Pediatrics, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Laura Moreno-Galarraga
- Department of Pediatrics, Hospital Universitario de Navarra, 31008 Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Correspondence: (L.M.-G.); (A.F.-M.); Tel.: +34-848429888 (L.M.-G.)
| | | | - Maria del Mar Bibiloni
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Miguel Ángel Martínez-González
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine and Public Health, Facultad de Medicina, Universidad de Navarra, 31008 Pamplona, Spain
- Pathophysiology of Obesity and Nutrition, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Víctor de la O
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine and Public Health, Facultad de Medicina, Universidad de Navarra, 31008 Pamplona, Spain
| | - Alejandro Fernandez-Montero
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Department of Occupational Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Correspondence: (L.M.-G.); (A.F.-M.); Tel.: +34-848429888 (L.M.-G.)
| | - Nerea Martín-Calvo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine and Public Health, Facultad de Medicina, Universidad de Navarra, 31008 Pamplona, Spain
- Pathophysiology of Obesity and Nutrition, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
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Berns M, Bayramova S, Kusztrich A, Metze B, Bührer C. Trend over 25 years of risk factors of mother's own milk provision to very low birth weight infants at discharge. Early Hum Dev 2023; 177-178:105730. [PMID: 36822127 DOI: 10.1016/j.earlhumdev.2023.105730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Feeding mother's own milk (MOM) is associated with reduced morbidity of very low birth weight (VLBW) infants (<1500 g), but not all mothers are able to provide pumped breast milk or breastfeed until discharge. AIMS To investigate the duration of MOM feeding and identify risk factors for cessation. STUDY DESIGN Single-center retrospective cohort study. SUBJECTS 307 VLBW infants born 2012 and 2019 surviving beyond 7 days of life. OUTCOME MEASURES Analysis of MOM feeding at discharge, including comparison with a historical cohort of infants born 1992-1994. RESULTS MOM feeding was initiated in 178/180 infants (98.9 %) born in 2012 and in 123/127 infants (96.9 %) born in 2019 (p = 0.132), as compared to 73/89 (82 %) infants born 1992-1994 (p < 0.001). Median [range] duration of MOM feeding was similar for infants born in 2012 (45 [0-170] days) and 2019 (50 [0-190] days) (p = 0.396), but much longer than in the historical cohort (36 [0-152] days) (p < 0.001). The overall breastfeeding rate increased up to 69.2 % and 77.2 %. Factors associated with cessation of MOM feeding were smoking during pregnancy, single-mother status, short (<12 years) duration of maternal or paternal school education (all p ≤ 0.001), natural conception, birth weight ≥ 1000 g, and gestational age ≥ 29 weeks (p < 0.05). In Cox proportional hazard multivariate analysis, smoking during pregnancy and single-mother status remained independent risk factors. CONCLUSIONS Duration of MOM feeding and breastfeeding rates of VLBW infants during hospital stay have increased significantly during the last 30 years, while smoking and indicators of low socioeconomic status remain dominant predictors of cessation of MOM feeding.
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Affiliation(s)
- Monika Berns
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sabahat Bayramova
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ariane Kusztrich
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Metze
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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12
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Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm. Pediatr Res 2023:10.1038/s41390-022-02437-6. [PMID: 36694025 DOI: 10.1038/s41390-022-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Motor impairment is common after extremely preterm (EPT, <28 weeks' gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD. METHODS Data come from a European population-based cohort of children born EPT in 2011-2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children - 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children. RESULTS Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4-3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6-2.6) and severe brain lesions, but at a much lower order of magnitude. CONCLUSION CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD. IMPACT Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties. Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors. These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.
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13
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Perrella SL, Anderton-May EL, McLoughlin G, Lai CT, Simmer KN, Geddes DT. Human Milk Sodium and Potassium as Markers of Mastitis in Mothers of Preterm Infants. Breastfeed Med 2022; 17:1003-1010. [PMID: 36378839 DOI: 10.1089/bfm.2022.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This prospective longitudinal study examined changes in milk sodium concentration (Na) and sodium:potassium ratio (Na:K), microbiological culture, milk production, and breast health in relation to mastitis after preterm birth. Methods: We studied women who gave birth at 29-34 weeks of gestation in a tertiary obstetric hospital in Perth, Western Australia. Milk samples, 24-hour milk production, and breast health data were collected every second day to day 10 postpartum, then every third day until infant discharge from the neonatal unit. Milk Na and K were measured at point of care (POC) using handheld ion selective meters, and Na:K calculated. Cultures were performed on postnatal days 8, 13, and every 6 days thereafter. For episodes of mastitis, milk was cultured at onset, and Na and Na:K measured daily until resolution. Women were followed up at 4 and 8 weeks postpartum. Results: In a sample of 44 women, 4 mastitis cases were detected in 3 women during their infants' neonatal stay; all had elevated milk Na and Na:K that resolved within 48 hours; 2/4 experienced reduced milk production and 1/4 had heavy growth of Staphylococcus epidermidis. A further 2 mastitis cases were reported in 39 women followed up to 8 weeks postpartum. Four women had elevated milk Na and Na:K without clinical signs of mastitis; three also had reduced milk production. Conclusions: POC testing of milk Na and/or Na:K may offer a useful indicator of breast health. Mastitis may cause an acute reduction in milk production regardless of the presence of culture-positive infection.
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Affiliation(s)
- Sharon Lisa Perrella
- School of Molecular Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Emma-Lee Anderton-May
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Grace McLoughlin
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ching Tat Lai
- School of Molecular Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Karen Norrie Simmer
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna Tracy Geddes
- School of Molecular Science, The University of Western Australia, Crawley, Western Australia, Australia
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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15
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Costa R, Aubert AM, Seppänen AV, Ådén U, Sarrechia L, Zemlin M, Cuttini M, Männamaa M, Pierrat V, van Heijst A, Barros H, Johnson S, Zeitlin J. Motor-related health care for 5-year-old children born extremely preterm with movement impairments. Dev Med Child Neurol 2022; 64:1131-1144. [PMID: 35298035 DOI: 10.1111/dmcn.15202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 01/24/2023]
Abstract
AIM To (1) determine the proportion of 5-year-old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor-related health care (MRHC), and (2) describe factors associated with receiving MRHC. METHOD Children born before 28 weeks' gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent-report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC-2 score 6th-15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP. RESULTS Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months-7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties. INTERPRETATION Efforts are needed to increase MRHC for 5-year-old children born EPT with movement difficulties. WHAT THIS PAPER ADDS Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor-related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.
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Affiliation(s)
- Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Adrien M Aubert
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
| | - Anna-Veera Seppänen
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michael Zemlin
- Department of Medicine, University of Saarland, Saarland, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer Zeitlin
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
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16
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Encourage, Assess, Transition (EAT): A Quality Improvement Project Implementing a Direct Breastfeeding Protocol for Preterm Hospitalized Infants. Adv Neonatal Care 2022; 23:107-119. [PMID: 36037212 DOI: 10.1097/anc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals. PURPOSE To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants. METHODS Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit. RESULTS Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%. IMPLICATIONS FOR PRACTICE AND RESEARCH Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.Video abstract available at: https://journals.na.lww.com/advancesinneonatalcare/pages/videogallery.aspx?autoPlay=false&videoId=61.
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17
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Keir A, Rumbold A, Collins CT, McPhee AJ, Varghese J, Morris S, Sullivan TR, Leemaqz S, Middleton P, Makrides M, Best KP. Breastfeeding outcomes in late preterm infants: A multi-centre prospective cohort study. PLoS One 2022; 17:e0272583. [PMID: 35969612 PMCID: PMC9377594 DOI: 10.1371/journal.pone.0272583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To describe (1) infant feeding practices during initial hospitalisation and up to 6 months corrected age (CA) in infants born late preterm with mothers intending to breastfeed, (2) the impact of early feeding practices on hospital length of stay and (3) maternal and infant factors associated with duration of breastfeeding. Methods We conducted a prospective cohort study of infants born at 34+0 to 36+6 weeks gestational age during 2018–2020. Families were followed up until the infant reached 6 months of age (corrected for prematurity). Feeding practices during the birth hospitalisation, length of initial hospital stay, and the prevalence of exclusive or any breastfeeding at 6 weeks, 3 months, and 6 months CA were examined. Associations between maternal and infant characteristics and breastfeeding at 6 weeks, 3 months and 6 months CA were assessed using multivariable logistic regression models. Results 270 infants were enrolled, of these, 30% were multiple births. Overall, 78% of infants received only breastmilk as their first feed, and 83% received formula during the hospitalisation. Seventy-four per cent of infants were exclusively breastfed at discharge, 41% at 6 weeks CA, 35% at 3 months CA, and 29% at 6 months CA. The corresponding combined exclusive and partial breastfeeding rates (any breastfeeding) were 72%, 64%, and 53% of babies at 6 weeks CA, 3 months CA, and 6 months CA, respectively. The mean duration of hospitalisation was 2.9 days longer (95% confidence interval (CI) 0.31, 5.43 days) in infants who received any formula compared with those receiving only breastmilk (adjusted for GA, maternal age, multiple birth, site, and neonatal intensive care unit admission). In multivariable models, receipt of formula as the first milk feed was associated with a reduction in exclusive breastfeeding at 6 weeks CA (odds ratio = 0.22; 95% CI 0.09 to 0.53) and intention to breastfeed >6 months with an increase (odds ratio = 4.98; 95% CI 2.39 to 10.40). Intention to breastfeed >6 months remained an important predictor of exclusive breastfeeding at 3 and 6 months CA. Conclusions Our study demonstrates that long-term exclusive breastfeeding rates were low in a cohort of women intending to provide breastmilk to their late preterm infants, with approximately half providing any breastmilk at 6 months CA. Formula as the first milk feed and intention to breastfeed >6 months were significant predictors of breastfeeding duration. Improving breastfeeding outcomes may require strategies to support early lactation and a better understanding of the ongoing support needs of this population.
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Affiliation(s)
- Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Department of Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
- * E-mail:
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Andrew J. McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Jojy Varghese
- Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Scott Morris
- Department of Neonatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
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18
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Twilhaar ES, Pierrat V, Marchand-Martin L, Benhammou V, Kaminski M, Ancel PY. Profiles of Functioning in 5.5-Year-Old Very Preterm Born Children in France: The EPIPAGE-2 Study. J Am Acad Child Adolesc Psychiatry 2022; 61:881-891. [PMID: 34508804 DOI: 10.1016/j.jaac.2021.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Very preterm born children are at risk for impairments in multiple neurodevelopmental domains, but outcomes vary between individuals. The present study aimed to distinguish subgroups with distinct profiles of functioning across motor, cognitive, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors. METHOD The sample included 1977 children born very preterm (<32 weeks' gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on their functioning at 5.5 years. The relation between outcome profiles and neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis. RESULTS Four subgroups with distinct outcome profiles were distinguished: no deficit in any domain (45%); motor and cognitive deficits without behavioral/psychosocial deficits (31%); primarily behavioral and psychosocial deficits (16%); and deficits in multiple domains (8%). Male sex (odds ratio [OR] = 2.1-2.7), bronchopulmonary dysplasia (OR = 2.1-2.8), low parental education level (OR = 1.8-2.1), and parental non-European immigrant status (OR = 2.3-3.0) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile. CONCLUSION Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors may be useful for early identification of very preterm born children at risk for general rather than domain-specific impairments.
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Affiliation(s)
- E Sabrina Twilhaar
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Véronique Pierrat
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Valérie Benhammou
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Monique Kaminski
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Assistance Publique-Hôpitaux de Paris, Clinical Investigation Center P1419, Paris, France
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19
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Rodrigues C, Zeitlin J, Zemlin M, Wilson E, Pedersen P, Barros H. Never‐breastfed children face a higher risk of suboptimal cognition at 2 years of corrected age: A multinational cohort of very preterm children. MATERNAL & CHILD NUTRITION 2022; 18:e13347. [PMID: 35294101 PMCID: PMC9218322 DOI: 10.1111/mcn.13347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
In a cohort of children born very preterm (VPT), we investigated the association between breast milk feeding (BMF) initiation and its duration on cognitive development at 2 years of corrected age. Data were obtained from the Effective Perinatal Intensive Care in Europe population‐based prospective cohort of children born <32 weeks of gestation, in 11 European countries, in 2011–2012. The study sample included 4323 children. Nonverbal cognitive ability was measured applying the Parental Report of Children's Abilities, except for France where the problem‐solving domain of the Ages & Stages Questionnaire was used. Verbal cognition was based on the number of words the child could say. To determine the association between BMF (mother's own milk) and nonverbal and verbal cognition (outcome categorized as optimal and suboptimal), adjusted risk ratios (aRRs) were estimated fitting Poisson regression models, with inverse probability weights to account for nonresponse bias. Overall, 16% and 11% of the children presented suboptimal nonverbal and verbal cognition, respectively. Never BMF was associated with a significantly increased risk for suboptimal nonverbal (aRR = 1.29, 95% confidence interval [CI] = 1.09–1.53) and verbal (aRR = 1.45, 95% CI = 1.09–1.92) cognitive development compared with those ever breastfed, after adjustment for perinatal and sociodemographic characteristics. Compared with children breastfed 6 months or more, children with shorter BMF duration exhibited a statistically nonsignificant elevated aRR. VPT children fed with breast milk had both improved nonverbal and verbal cognitive development at 2 years in comparison with never breastfed, independently of perinatal and sociodemographic characteristics. This study encourages targeted interventions to promote BMF among these vulnerable children. In a European cohort of children born very preterm, 16% and 11% presented suboptimal nonverbal and verbal cognitive development, respectively. Never‐breastfed children faced a higher risk of having suboptimal nonverbal and verbal cognition at 2 years of corrected age when compared with those who were breastfed, independently of perinatal and sociodemographic characteristics. Breastfeeding support is a modifiable factor regardless of perinatal and sociodemographic characteristics, which reinforces the importance of specifically targeted interventions to protect, promote and support breast milk feeding in neonatal intensive care units and after discharge.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit, Instituto de Saúde Pública Universidade do Porto Porto Portugal
| | - Jennifer Zeitlin
- CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé) INSERM, INRA, Université de Paris Paris France
| | - Michael Zemlin
- Department of Neonatology and Pediatrics University Children's Hospital of Saarland Homburg Germany
| | - Emilija Wilson
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | | | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública Universidade do Porto Porto Portugal
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20
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Aubert AM, Costa R, Ådén U, Cuttini M, Männamaa M, Pierrat V, Sarrechia I, van Heijst AF, Zemlin M, Johnson S, Zeitlin J. Movement Difficulties at Age Five Among Extremely Preterm Infants. Pediatrics 2022; 149:188130. [PMID: 35615946 DOI: 10.1542/peds.2021-054920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born extremely preterm (EPT), <28 weeks' gestational age, face higher risks of movement difficulties than their term-born peers. Studies report varying prevalence estimates and prognostic factors identifying children who could benefit from early intervention are inconsistent. This study investigated the prevalence of movement difficulties in children born EPT and associated risk factors. METHODS Data come from a population-based EPT birth cohort in 2011 and 2012 in 11 European countries. Children without cerebral palsy were assessed at 5 years of age (N = 772) with the Movement Assessment Battery for Children-Second Edition, which classifies movement difficulties as none (>15th percentile), at risk (6th-15th percentile) and significant (≤5th percentile). Associations with sociodemographic, perinatal, and neonatal characteristics collected from obstetric and neonatal medical records and parental questionnaires were estimated using multinomial logistic regression. RESULTS We found 23.2% (n = 179) of children were at risk for movement difficulties and 31.7% (n = 244) had significant movement difficulties. Lower gestational age, severe brain lesions, and receipt of postnatal corticosteroids were associated with significant movement difficulties, whereas male sex and bronchopulmonary dysplasia were associated with being at risk and having significant movement difficulties. Children with younger, primiparous, less educated, and non-European-born mothers were more likely to have significant movement difficulties. Differences in prevalence between countries remained after population case-mix adjustments. CONCLUSIONS This study confirms a high prevalence of movement difficulties among EPT children without cerebral palsy, which are associated with perinatal and neonatal risk factors as well as sociodemographic characteristics and country.
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Affiliation(s)
- Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Iemke Sarrechia
- Department of Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Arno F van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Hospital, 66421 Homburg, Germany
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
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21
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Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
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22
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Bably MB, Laditka SB, Paul R, Racine EF. Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WIC. Child Obes 2022; 18:197-205. [PMID: 34551266 DOI: 10.1089/chi.2021.0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Children's age at bottle weaning typically ranges from 12 to 24 months. The recommended age of bottle weaning varies. The American Academy of Pediatrics recommends weaning by 12 months; The American Academy of Pediatric Dentistry recommends 12-15 months; The US Department of Agriculture recommends 18 months. Prolonged bottle use is associated with dental caries, iron-deficiency anemia, and child overweight or obesity. We examined factors associated with age of bottle cessation, and the association between age of bottle cessation and BMI-for-age percentile at age 36 months among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants. Methods: Data were from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2). The ITFPS-2, a longitudinal study of WIC participants (mothers and their children) began in 2013. We used Cox proportional hazards models to identify factors associated with bottle cessation and multivariate linear regression to examine the association between age of bottle cessation and BMI. Results: About 34% of children used a bottle longer than 12 months, and 13% longer than 18 months. Bottle cessation at older ages was associated with Hispanic ethnicity, multiparity, low income, low education, higher caregiver weight, and not initiating breastfeeding. The adjusted children's BMI-for-age percentile at age 36 months increased by 0.47 for each additional month of bottle use. Conclusion: Prolonged bottle use was associated with increased children's BMI-for-age percentile. Future research is warranted to determine the optimal age to recommend bottle cessation for WIC participants.
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Affiliation(s)
- Morium B Bably
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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23
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Seppänen AV, Draper ES, Petrou S, Barros H, Aubert AM, Andronis L, Kim SW, Maier RF, Pedersen P, Gadzinowski J, Lebeer J, Ådén U, Toome L, van Heijst A, Cuttini M, Zeitlin J. High Healthcare Use at Age 5 Years in a European Cohort of Children Born Very Preterm. J Pediatr 2022; 243:69-77.e9. [PMID: 34921871 DOI: 10.1016/j.jpeds.2021.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe parent-reported healthcare service use at age 5 years in children born very preterm and investigate whether perinatal and social factors and the use of very preterm follow-up services are associated with high service use. STUDY DESIGN We used data from an area-based cohort of births at <32 weeks of gestation from 11 European countries, collected from birth records and parental questionnaires at 5 years of age. Using the published literature, we defined high use of outpatient/inpatient care (≥4 sick visits to general practitioners, pediatricians, or nurses, ≥3 emergency room visits, or ≥1 overnight hospitalization) and specialist care (≥2 different specialists or ≥3 visits). We also categorized countries as having either a high or a low rate of children using very preterm follow-up services at age 5 years. RESULTS Overall, 43% of children had high outpatient/inpatient care use and 48% had high specialist care use during the previous year. Perinatal factors were associated with high outpatient/inpatient and specialist care use, with a more significant association with specialist services. Associations with intermediate parental educational level and unemployment were stronger for outpatient/inpatient services. Living in a country with higher rates of very preterm follow-up service use was associated with lower use of outpatient/inpatient services. CONCLUSIONS Children born very preterm had high healthcare service use at age 5 years, with different patterns for outpatient/inpatient and specialist care by perinatal and social factors. Longer follow-up of children born very preterm may improve care coordination and help avoid undesirable health service use.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Henrique Barros
- Epidemiology Research Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Adrien M Aubert
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
| | - Lazaros Andronis
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sung Wook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rolf F Maier
- Department of Neonatology, Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
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24
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Laborie S, Abadie G, Denis A, Touzet S, Fischer Fumeaux CJ. A Positive Impact of an Observational Study on Breastfeeding Rates in Two Neonatal Intensive Care Units. Nutrients 2022; 14:nu14061145. [PMID: 35334802 PMCID: PMC8951536 DOI: 10.3390/nu14061145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023] Open
Abstract
We aimed to investigate whether the participation in an observational study on breastfeeding (Doal) modified breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). This bi-centric before-and-after study included neonates who were admitted during a 4-month period before and a 4-month period after the implementation of Doal. Breastfeeding intention and breastfeeding rates at discharge were compared between the two periods. The association between inclusion in Doal and breastfeeding at discharge was assessed among the infants fulfilling the inclusion criteria of Doal. The present study included 655 neonates. After adjustments, both breastfeeding (aOR 1.21, 95%CI [1.1; 1.4], p = 0.001) and exclusive breastfeeding (aOR 1.8, 95%CI [1.4; 2.3], p < 0.001) at discharge increased in the period after. Breastfeeding intention was higher in one center in the period after (79%) compared to before (59%, p = 0.019). Compared to the period before, neonates who were not included in Doal in the period after had a lower chance to be breastfed at discharge, whereas those included were more frequently exclusively breastfed. The participation in an observational study on breastfeeding was associated with an increase in breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). Patients who are not included deserve attention as they are at risk to be disadvantaged regarding breastfeeding success.
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Affiliation(s)
- Sophie Laborie
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France
- Correspondence: ; Tel.: +33-427855284
| | - Géraldine Abadie
- Réanimation Pédiatrique et Médecine Néonatale, CHU Félix Guyon, 97405 Saint Denis de la Réunion, France;
| | - Angélique Denis
- Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, CNRS, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France;
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, UMR 5558, CNRS, 69100 Villeurbanne, France
| | - Sandrine Touzet
- Service de Recherche Clinique et Épidémiologique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
- Research on Healthcare Performance Lab, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Céline J. Fischer Fumeaux
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
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25
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Rodrigues C, Zeitlin J, Carvalho AR, Gonzaga D, Barros H. Behavioral and emotional outcomes at preschool age in children born very preterm: The role of breast milk feeding practices. Early Hum Dev 2022; 165:105535. [PMID: 35038626 DOI: 10.1016/j.earlhumdev.2021.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Breast milk feeding (BMF) improved neurodevelopment in children born very preterm (VPT, <32 weeks of gestation), but knowledge about its effect on other mental health outcomes remains limited. OBJECTIVE To estimate the association of BMF practices with behavioral and emotional problems at preschool age in children born VPT. METHODS We studied 263 children born VPT during 2011-12 and enrolled in the Portuguese EPICE cohort. At the age of 3, information on BMF initiation and duration was collected and behavioral and emotional problems were assessed using the parents' completed Child Behavior Checklist 1.5-5 years (CBCL/1½-5). Children were categorized for all CBCL/1½-5 sub-scales and for Diagnostic and Statistical Manual of Mental Disorders (DSM5)-oriented scales. Risk ratios were estimated to assess the association of BMF with subclinical/clinical problems, fitting a Poisson regression. RESULTS Behavioral or emotional subclinical/clinical problems were found in almost 20% of children (11.8% in the clinical range). BMF was consistently associated with lower adverse behavioral and emotional outcomes, particularly risks of externalizing problems, somatic complaints, aggressive behavior, as well as autism spectrum and attention deficit/hyperactivity symptoms, although the magnitude of the unadjusted risks was attenuated by adjustment for relevant confounders and wider confidence intervals included the null. CONCLUSION Lower exposure to BMF seemed to increase the risk of adverse behavioral and emotional outcomes at preschool age in children born VPT. These results raise questions about explanatory pathways and strengthen evidence underpinning BMF promotion for VPT children.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
| | - Ana Raquel Carvalho
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Gonzaga
- Centro Materno-Infantil do Norte, Centro Hospital Universitário do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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Factors Associated with the Initiation of Added Sugar among Low-Income Young Children Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in the US. Nutrients 2021; 13:nu13113888. [PMID: 34836143 PMCID: PMC8624134 DOI: 10.3390/nu13113888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022] Open
Abstract
Added sugar intake at a young age is associated with chronic diseases including cardiovascular diseases, asthma, elevated blood pressure, and overweight. The Dietary Guidelines for Americans 2020–2025 and the American Heart Association recommend delaying the introduction of added sugar until age 2. The aims of this study were to identify the timing of added sugar initiation; factors associated with added sugar initiation; and the top five added sugar foods and beverages consumed by infants and children at three age ranges (<7 months, 8–13 months, and 14–24 months). Data were from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2, a longitudinal, national population of WIC participants enrolled in WIC eligible clinics (n = 3835). The Cox proportional hazards model was used to examine the factors associated with introducing added sugar. About 25% of children were given added sugar at or before 7 months. Contributing factors were caregivers’ race/ethnicity, education, employment, weight status, parity, child sex, and premature birth (all p < 0.05). The top added sugar foods consumed between 1–24 months were cereal, crackers, apple sauce, dessert, yogurt, sweetened beverages, syrup and preserves, and cookies. Further research to examine the impact of early initiation of added sugar on health outcomes and taste preferences is warranted.
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Parker LA, Krueger C, Sullivan S, Mueller M. Demographic, Social, and Personal Factors Associated With Lactation Cessation by 6 Weeks in Mothers of Very Low Birth Weight Infants. J Hum Lact 2021; 37:511-520. [PMID: 33030992 DOI: 10.1177/0890334420940239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although mother's own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant. RESEARCH AIM To determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants. METHODS We used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation. RESULTS Participants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p = .019), Medicaid eligible (p = .009), less educated (p < .031), smoke (p = .002), provide less skin-to-skin care (p = .007), and to delay the decision to provide their milk to their infant (p = .007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation. CONCLUSION While the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother's own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population.This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013.
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28
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El Rafei R, Jarreau PH, Norman M, Maier RF, Barros H, Van Reempts P, Pedersen P, Cuttini M, Costa R, Zemlin M, Draper ES, Zeitlin J. Association between postnatal growth and neurodevelopmental impairment by sex at 2 years of corrected age in a multi-national cohort of very preterm children. Clin Nutr 2021; 40:4948-4955. [PMID: 34358841 DOI: 10.1016/j.clnu.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/05/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS Extra-uterine growth restriction (EUGR) is common among very preterm (VPT) infants and has been associated with impaired neurodevelopment. Some research suggests that adverse effects of EUGR may be more severe in boys. We investigated EUGR and neurodevelopment at 2 years of corrected age (CA) by sex in a VPT birth cohort. METHODS Data come from a population-based cohort of children born <32 weeks' gestation from 11 European countries and followed up at 2 years CA. Postnatal growth during the neonatal hospitalization was measured with: (1) birthweight and discharge-weight Z-score differences using Fenton charts (2) weight-gain velocity using Patel's model. Published cut-offs were used to define EUGR as none, moderate or severe. Neurodevelopmental impairment was assessed using a parent-report questionnaire, with standardized questions/instruments on motor function, vision, hearing and non-verbal cognition. We estimated relative risks (RR) adjusting for maternal and neonatal characteristics overall and by sex. RESULTS Among 4197 infants, the prevalence of moderate to severe impairment at 2 years CA was 17.7%. Severe EUGR was associated with neurodevelopmental impairment in the overall sample and the interaction with sex was significant. For boys, adjusted RR were 1.57 (95% Confidence Intervals (CI): 1.18-2.09) for Fenton's delta Z-score and 1.50 (95% CI: 1.12-2.01) for Patel's weight-gain velocity, while for girls they were 0.97 (0.76-1.22) and 1.12 (0.90-1.40) respectively. CONCLUSION EUGR was associated with poor neurodevelopment at 2 years among VPT boys but not girls. Understanding why boys are more susceptible to the effects of poor growth is needed to develop appropriate healthcare strategies.
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Affiliation(s)
- Rym El Rafei
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France; Sorbonne Université, Collège Doctoral, F-75005, Paris, France.
| | - Pierre Henri Jarreau
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Patrick Van Reempts
- Laboratory of Experimental Medicine and Pediatrics, Division of Neonatology, University of Antwerp, Antwerp, Belgium; Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | | | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Raquel Costa
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
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29
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Abstract
Breast milk provides optimal nourishment for all infants and has special advantages in preterm infants. Breast milk is associated with lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia and improved neurodevelopmental outcomes in the preterm population. Mothers in the NICU may experience multiple psychological, physical, and social/cultural barriers that impede successful breastfeeding. Professional lactation support is of crucial importance in this population. With the social distancing requirements of the pandemic, many clinicians have adopted novel methods of education and communication to ensure continued timely support for NICU mothers.
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Affiliation(s)
- Padma S Nandula
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
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30
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Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
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31
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Mother's Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084140. [PMID: 33919856 PMCID: PMC8070824 DOI: 10.3390/ijerph18084140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
Early nutrition of newborns significantly influences their long-term health. Mother's own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother-baby dyads at risk of non-MOM feeding.
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32
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Zeitlin J, Maier RF, Cuttini M, Aden U, Boerch K, Gadzinowski J, Jarreau PH, Lebeer J, Norman M, Pedersen P, Petrou S, Pfeil JM, Toome L, van Heijst A, Van Reempts P, Varendi H, Barros H, Draper ES. Cohort Profile: Effective Perinatal Intensive Care in Europe (EPICE) very preterm birth cohort. Int J Epidemiol 2021; 49:372-386. [PMID: 32031620 PMCID: PMC7266542 DOI: 10.1093/ije/dyz270] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/12/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ulrika Aden
- Department of Womeńs and Childreńs Health, Karolinska Institutet, Stockholm, Sweden
| | - Klaus Boerch
- Department of Paediatrics, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Pierre-Henri Jarreau
- Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, DHU Risks in pregnancy, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Jo Lebeer
- Department of Primary & Interdisciplinary Care, Disability Studies, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stavros Petrou
- The University of Warwick, Warwick Medical School (WMS), Coventry, UK.,University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Johanna M Pfeil
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia and University of Tartu, Tartu, Estonia
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium and Study Centre for Perinatal Epidemiology, Brussels, Belgium
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Henrique Barros
- EPIUnit--Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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33
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Ericson J, Lampa E, Flacking R. Breastfeeding satisfaction post hospital discharge and associated factors - a longitudinal cohort study of mothers of preterm infants. Int Breastfeed J 2021; 16:28. [PMID: 33766069 PMCID: PMC7992863 DOI: 10.1186/s13006-021-00374-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Mothers’ satisfaction with breastfeeding is important for breastfeeding duration but rarely investigated in mothers of preterm infants. The aim of this study was to describe breastfeeding satisfaction and associated factors during the first year in mothers of preterm infants (gestational age < 37 weeks). Methods This longitudinal cohort study, based on secondary analysis data from a randomized controlled trial, included 493 mothers of 547 preterm infants. Data on breastfeeding duration and satisfaction, parental stress and attachment were collected at 8 weeks post discharge, and at 6 and 12 months after birth. Breastfeeding satisfaction was measured by the Maternal Breastfeeding Evaluation Scale. Descriptive statistics and linear mixed effect models were used when analyzing the data. Results During the first 12 months breastfeeding satisfaction increased in the mean summary scores and points in the dimensions “role attainment” and “lifestyle and maternal body image”. In the dimension “infant growth and satisfaction”, there was an increase in mean points from 6 to 12 months after birth, but not between 8 weeks after discharge and 12 months after birth. The findings also showed that partial and no breastfeeding, higher parental stress, and infant gestational age < 32 weeks were associated with decreased breastfeeding satisfaction. Older maternal age and greater maternal attachment were associated with increased maternal breastfeeding satisfaction. There were no associations between maternal breastfeeding satisfaction and maternal educational level, parity, multiple birth, or maternal birth country other than Sweden, during the first 12 months after birth. Conclusions Breastfeeding satisfaction was clearly associated with breastfeeding duration during the first year after birth. Breastfeeding satisfaction may be important to take into account when supporting breastfeeding and when designing interventions to support breastfeeding. Furthermore, these findings highlight the complexity of breastfeeding and emphasize the need for early and good support during neonatal care, so that mothers feel trust in themselves and their infant and in exclusive breastfeeding at discharge and in the first months thereafter. Trial registration The randomized controlled trial was registered NCT01806480 with www.clinicaltrials.gov on 2013-03-07.
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Affiliation(s)
- Jenny Ericson
- Department of Pediatrics, Falu Hospital, Falun, Sweden. .,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
| | - Erik Lampa
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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34
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Seppänen AV, Sauvegrain P, Draper ES, Toome L, El Rafei R, Petrou S, Barros H, Zimmermann LJI, Cuttini M, Zeitlin J. Parents' ratings of post-discharge healthcare for their children born very preterm and their suggestions for improvement: a European cohort study. Pediatr Res 2021; 89:1004-1012. [PMID: 32947602 DOI: 10.1038/s41390-020-01120-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Follow-up of very preterm infants is essential for reducing risks of health and developmental problems and relies on parental engagement. We investigated parents' perceptions of post-discharge healthcare for their children born very preterm in a European multi-country cohort study. METHODS Data come from a 5-year follow-up of an area-based cohort of births <32 weeks' gestation in 19 regions from 11 European countries. Perinatal data were collected from medical records and 5-year data from parent-report questionnaires. Parents rated post-discharge care related to their children's preterm birth (poor/fair/good/excellent) and provided free-text suggestions for improvements. We analyzed sociodemographic and medical factors associated with poor/fair ratings, using inverse probability weights to adjust for attrition bias, and assessed free-text responses using thematic analysis. RESULTS Questionnaires were returned for 3635 children (53.8% response rate). Care was rated as poor/fair for 14.2% [from 6.1% (France) to 31.6% (Denmark)]; rates were higher when children had health or developmental problems (e.g. cerebral palsy (34.4%) or epilepsy (36.9%)). From 971 responses, 4 themes and 25 subthemes concerning care improvement were identified. CONCLUSIONS Parents' experiences provide guidance for improving very preterm children's post-discharge care; this is a priority for children with health and developmental problems as parental dissatisfaction was high. IMPACT In a European population-based very preterm birth cohort, parents rated post-discharge healthcare as poor or fair for 14.2% of children, with a wide variation (6.1-31.6%) between countries. Dissatisfaction was reported in over one-third of cases when children had health or developmental difficulties, such as epilepsy or cerebral palsy. Parents' free-text suggestions for improving preterm-related post-discharge healthcare were similar across countries; these focused primarily on better communication with parents and better coordination of care. Parents' lived experiences are a valuable resource for understanding where care improvements are needed and should be included in future research.
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Affiliation(s)
- Anna-Veera Seppänen
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, 75004, Paris, France.
- Sorbonne Université Collège Doctoral, 75005, Paris, France.
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, 75004, Paris, France
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia
- University of Tartu, Tartu, Estonia
| | - Rym El Rafei
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, 75004, Paris, France
- Sorbonne Université Collège Doctoral, 75005, Paris, France
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
- Department of Paediatrics, Research School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, 75004, Paris, France
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35
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Zengin Akkus P, Bahtiyar Saygan B, Ilter Bahadur E, Ozdemir G, Celik HT, Ozmert EN. Longitudinal changes in attachment patterns of preterm infants born in a non-Western country. Infant Ment Health J 2021; 42:517-528. [PMID: 33410526 DOI: 10.1002/imhj.21906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.
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Affiliation(s)
- P Zengin Akkus
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - E Ilter Bahadur
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G Ozdemir
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H T Celik
- Department of Pediatrics, Department of Neonatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E N Ozmert
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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36
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Laksono AD, Wulandari RD, Ibad M, Kusrini I. The effects of mother's education on achieving exclusive breastfeeding in Indonesia. BMC Public Health 2021; 21:14. [PMID: 33402139 PMCID: PMC7786474 DOI: 10.1186/s12889-020-10018-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though the Indonesian government have set regulations for maintaining exclusive breastfeeding practices, the coverage remains low. The study aims to analyze the effects of mother's education level on the coverage of exclusive breastfeeding in Indonesia. METHODS This study used data from the 2017 Nutrition Status Monitoring Survey. It covered data of 53,528 children under 5 years old (7-59 months) as the samples. Variables included exclusive breastfeeding status, mother's education level, mother's age, marital status, employment status, gender, residence, under five's age and gender. A binary logistics regression was performed in the final test. RESULTS Mothers who graduated from elementary school were 1.167 times more likely to perform exclusive breastfeeding compared to mothers who never attended schools. Additionally, those who graduated from junior high school had 1.203 times possibilities to give exclusive breastfeeding compared to mothers without educational records. While, mothers who graduated from high school were 1.177 times more likely to perform exclusive breastfeeding compared to those without educational records. Mothers who graduated from tertiary education had 1.203 times more possibilities to perform exclusive breastfeeding compared to mothers who were never enrolled to schools. Other variables also became affecting predictors on exclusive breastfeeding, such as mother's age, mother's employment status, child's age, and residence. CONCLUSIONS The mother's education level positively affects exclusive breastfeeding practice in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- National Institute of Health Research and Development, the Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia.,Doctoral Program, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | | | - Mursyidul Ibad
- Faculty of Health, Nadlatul Ulama University, Surabaya, Indonesia
| | - Ina Kusrini
- Unit of Health Research and Development Magelang, Ministry of Health, Center Java, Java, Indonesia
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37
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Abdul Hamid H, Szatkowski L, Budge H, Cheah FC, Ojha S. Nutritional practices and growth of preterm infants in two neonatal units in the UK and Malaysia: a prospective exploratory study. BMJ Paediatr Open 2021; 5:e001153. [PMID: 34514178 PMCID: PMC8386205 DOI: 10.1136/bmjpo-2021-001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To explore differences in nutritional practices and growth outcomes among preterm infants in neonatal units in Malaysia and the UK. DESIGN Prospective exploratory study of infants born at <34 weeks gestational age (GA). SETTING Two neonatal units, one in Malaysia and one in the UK (May 2019 to March 2020). METHODS Data collected from birth until discharge and compared between units. RESULTS From 100 infants included, median GA (IQR) was 31 (30-33) and mean±SD birth weight was 1549±444 g. There were more small-for-gestational age infants in Malaysian unit: 12/50 (24%) vs UK: 3/50 (6%), p=0.012 and more morbidities. More Malaysian infants received breast milk (Malaysia: 49 (98%) vs UK: 38 (76%), p=0.001), fortified breast milk (Malaysia: 43 (86%) vs UK: 13 (26%), p<0.001) and exclusive breast milk at discharge (Malaysia: 26 (52%) vs UK: 16 (32%), p=0.043). There was higher parenteral nutrition use among Malaysian infants (40/50 (80%)) vs UK (19/50 (38%)) (p<0.001) with higher protein intake (mean±SD Malaysia: 3.0±0.5 vs UK: 2.7±0.6 g/kg/d, p=0.004) in weeks 1-4 and smaller cumulative protein deficits (mean±SD Malaysia: 11.4±6.1 vs UK: 15.4±8.0 g/kg, p=0.006). There were no significant differences in short-term growth between units and more than half of the infants in both units had ≥1.28 changes in weight-for-age Z-score at discharge (p=0.841). CONCLUSIONS An exploratory comparison of practices showed differences in patient characteristics and nutritional practices which impacted growth. Future studies with larger sample sizes and detailed analysis of maternal characteristics and infants' outcomes are needed for improving care of preterm infants in all settings.
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Affiliation(s)
- Haslina Abdul Hamid
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Dietetic Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lisa Szatkowski
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Helen Budge
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fook-Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shalini Ojha
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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38
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Çelik K, Asena M, İpek MŞ. The trends in the usage of breast milk in neonatal intensive care setting. Pediatr Int 2020; 62:1064-1072. [PMID: 32315473 DOI: 10.1111/ped.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many interventions have been designed to increase breast milk (BM) consumption among preterm and critical-term infants in neonatal units. The aim of this study was to determine the trends in the usage of BM in a neonatal unit and the risk factors for insufficient breast-milk feeding at discharge. METHODS This retrospective study included newborn infants who hospitalized in the neonatal unit during two periods in different years, a 15-month period in 2012-2013 and in 2017-2018. The primary outcomes were the availability of BM within 24 h after delivery and the status of infant feeding at discharge. RESULTS During two periods of the study, a total of 3,018 infants were included in the study. The rate of BM expression within the first 24 h after delivery was 92.9%, and it was found that the first period of the study, caesarean section delivery, very low birth weight, being first-time mother, and young maternal age were each independently associated with the delayed initiation of BM expression (P < 0.05). At discharge, 87.6% of the infants had been feeding with BM. Multiple births, the delayed initiation of BM expression, and the length of hospital stay were associated with inadequate BM feeding at discharge (P < 0.001). CONCLUSION This study showed that interventions supporting BM feeding, which have recently been carried out, made improvements to the initiation of BM expression among mothers whose babies were admitted to the neonatal unit, and in the rate of BM feeding among infants at discharge.
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Affiliation(s)
- Kıymet Çelik
- Division of Neonatology, Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Muhammed Asena
- Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Şah İpek
- Division of Neonatology, Department of Pediatrics, Memorial Dicle Hospital, Diyarbakir, Turkey
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39
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Zukova S, Krumina V, Buceniece J. Breastfeeding preterm born infant: Chance and challenge. Int J Pediatr Adolesc Med 2020; 8:94-97. [PMID: 34084879 PMCID: PMC8144854 DOI: 10.1016/j.ijpam.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/24/2019] [Accepted: 02/04/2020] [Indexed: 10/26/2022]
Abstract
Background and Objectives For preterm infants, breastmilk plays an important role in their development, but mothers encounter a number of barriers to breastfeeding. The aim of this study was to investigate breastfeeding prevalence in preterm infants and to examine factors that may face mothers when starting to feed at-breast and their impact on the result. Methods Women (N = 79) with preterm infants (N = 84) were interviewed within the follow-up program in Latvia during a six-month period in 2018 using the original study protocol. Results 61.9% infants were breastfed and 38.1% were not. The median infant birth weight in breastfed group was 1730 g, the median duration of tube feeding 21 days. The median age when started to feed at-breast 33 days. Later only 40.4% infants were still feeding at-breast. A relationship was found between breastfeeding and the mother's confidence during pregnancy that she would breastfeed (P < .05). 98% mothers who began to feed at-breast, during pregnancy were confident that they would breastfeed. 54.2% women who started to breastfeed as success mentioned medical staff training, 29.2% family support.The median birth weight in the non-breastfed group was 1494 g, the median duration of tube feeding 21 days. 50% women who did not begin to breastfeed had not received enough information about breastfeeding; 17.2% during pregnancy were not confident that they would breastfeed. 38.7% women stated infants' inability to suckle as failure, 22.6% thought they had no milk. Mothers under 32 years were more likely not to breastfeed their infant (OR = 0.8, 95% CI 0.33-1.96). Conclusion Most mothers began to breastfeed immediately, less than half continued later. Women did not receive enough family support. Young maternal age was associated with decrease in breastfeeding. Mothers with higher education were more likely to breastfeed. Being born extremely preterm and very preterm were associated with the least chance of being breastfed.
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Affiliation(s)
- Svetlana Zukova
- Riga Stradins University, Faculty of Medicine, Pediatric Program, Dzirciema Street 16, Riga, Latvia
| | - Valda Krumina
- Children's Clinical University Hospital, Vienības Gatve Street 45, Riga, LV-1004, Latvia
| | - Jelena Buceniece
- Jekabpils Regional Hospital, A.Pormaļa Street 125, Jekabpils, LV-5201, Latvia
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40
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Sentenac M, Johnson S, Charkaluk ML, Sëppanen AV, Aden U, Cuttini M, Maier R, Mannamaa M, Zeitlin J. Maternal education and language development at 2 years corrected age in children born very preterm: results from a European population-based cohort study. J Epidemiol Community Health 2020; 74:346-353. [PMID: 31996408 DOI: 10.1136/jech-2019-213564] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Socioeconomic factors influence language development in the general population, but the association remains poorly documented in children born very preterm (VPT). We assessed the impact of maternal education on language development in children born VPT and effect modification by perinatal risk. METHODS Data were from the Effective Perinatal Intensive Care in Europe (EPICE) population-based cohort of children born <32 weeks' gestational age (GA) in 2011/2012. Regions from six countries (Estonia, France, Germany, Italy, Sweden and UK) used a validated short form MacArthur Developmental Communicative Inventories Checklist to assess language at 2 years corrected age. Perinatal variables were collected from clinical records. We assessed expressive language delay (ELD), defined as (a) not combining words; and (b) expressive vocabulary <10th percentile of norms for age and sex. Perinatal risk (low, moderate and high) was determined using GA, small for GA and neonatal morbidities. We estimated adjusted risk ratios (aRR) of ELD by maternal education with inverse weighting to account for non-response bias. RESULTS Of 2741 children, 24.6% were not combining words and 39.7% had a low expressive vocabulary. Low maternal education (lower secondary or less compared with a bachelor's degree or more) increased risks of ELD: not combining words: aRR=1.52 (95% CI 1.36 to 1.69); low expressive vocabulary: aRR=1.25 (1.04 to 1.51). For children with low perinatal risk, the aRR were 1.88 (1.26 to 2.80) and 1.44 (1.06 to 1.95), respectively, compared with those with high perinatal risks: 1.36 (1.10 to 1.67) and 1.11 (0.97 to 1.27), respectively. CONCLUSION Low maternal education affects ELD for children born VPT, although the association appears attenuated among those with highest perinatal risk.
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Affiliation(s)
- Mariane Sentenac
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Marie-Laure Charkaluk
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
- Université Catholique de Lille, Lille, France ; Service de néonatologie, Hôpital Saint Vincent de Paul, Groupement des Hôpitaux de l'Institut Catholique Lillois/Faculté de Médecine et Maïeutique, Lille, France
| | - Anna-Veera Sëppanen
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Ulrika Aden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Pediatric Hospital, Roma, Lazio, Italy
| | - Rolf Maier
- Children's Hospital, University Hospital, Philipps-University Marburg, Marburg, Germany
| | - Mairi Mannamaa
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
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Carcavalli L, Rocha IA, Valentim AF, Penido MG, Parlato EM, Pordeus IA, Serra-Negra JM. Difference of Socioeconomic Factors among Mothers of Preterm and Full-Term Infant. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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42
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Di Mario S, Gagliotti C, Donatini A, Battaglia S, Buttazzi R, Balduzzi S, Borsari S, Basevi V, Barbieri L. Formula feeding increases the risk of antibiotic prescriptions in children up to 2 years: results from a cohort study. Eur J Pediatr 2019; 178:1867-1874. [PMID: 31493020 DOI: 10.1007/s00431-019-03462-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 12/31/2022]
Abstract
Association between the use of infant formula and risks for infants' health is seldom studied in western countries. We set up a historical cohort based on record linkage analysis, combining the data from administrative databases providing individual data. Infants receiving the second dose of pediatric immunization between 2015 and 2017 were included. The main outcome measure was antibiotic prescriptions from enrolment up to 24 months of age, by infant feeding category at enrolment. The extended Cox regression technique was used to account for recurrent events. The infants' cohort included 40,258 5-month-old infants; during the study period, 60,932 antibiotic prescriptions were filled. Compared with infants fully breastfed, children fed with both maternal milk and formula received 106 more antibiotic prescriptions per 1000 children/year, whereas infants receiving formula only had 138 excess prescriptions per 1000 children/year. The association with infant feeding was statistically significant and remained unchanged after adjustment for common confounders (adjusted hazard ratio, HR, for complementary feeding vs full breastfeeding 1.09; 95%CI 1.05 to 1.12; formula only versus full breastfeeding adj. HR 1.12; 95%CI 1.08 to 1.16).Conclusion: In our cohort, we observed a positive association between infant formula use considered a proxy of infections antibiotic prescription rate, considered a proxy of infections. The association followed a gradient.What is Known:• Formula feeding is associated with increased morbidity and mortality even in western countries, but still, it is common.• Information on formula are seldom unbiased; thus, public perception of risks is distorted.What is New:• In a large Italian cohort of infants, formula feeding at 5 months of age results to be associated with an increased rate of antibiotic prescription (considered to be a proxy of infection) up to 24 months of age: the association follows a dose-response relationship.• Record linkage analysis using administrative databases provides useful information at a limited cost.
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Affiliation(s)
- Simona Di Mario
- SaPeRiDoc-Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy.
| | - Carlo Gagliotti
- Regional Health and Social Agency of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Andrea Donatini
- Primary Care Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Sergio Battaglia
- Information Technology Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Rossella Buttazzi
- Regional Health and Social Agency of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Sara Balduzzi
- Department of Medical and Surgical Sciences, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Borsari
- Primary Care Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Vittorio Basevi
- SaPeRiDoc-Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
| | - Luca Barbieri
- Primary Care Service, Regional Health Authority of Emilia-Romagna, viale Aldo Moro 21, 40127, Bologna, Italy
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Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, Thorkelsson T, Flacking R. Breastfeeding progression in late preterm infants from birth to one month. MATERNAL AND CHILD NUTRITION 2019; 16:e12893. [PMID: 31595692 PMCID: PMC7038874 DOI: 10.1111/mcn.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.
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Affiliation(s)
- Rakel B Jónsdóttir
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Arna Skúladóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Thordur Thorkelsson
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. MATERNAL AND CHILD NUTRITION 2019; 15:e12875. [PMID: 31310706 DOI: 10.1111/mcn.12875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Jeanne Fresson
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Clinical Epidemiology and Biostatistics, CHRU Nancy, Nancy, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
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45
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Seppänen AV, Bodeau-Livinec F, Boyle EM, Edstedt-Bonamy AK, Cuttini M, Toome L, Maier RF, Cloet E, Koopman-Esseboom C, Pedersen P, Gadzinowski J, Barros H, Zeitlin J. Specialist health care services use in a European cohort of infants born very preterm. Dev Med Child Neurol 2019; 61:832-839. [PMID: 30508225 DOI: 10.1111/dmcn.14112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 12/27/2022]
Abstract
AIM Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France.,Collège Doctoral, Sorbonne Université, Paris, France
| | - Florence Bodeau-Livinec
- Ecole des Hautes Etudes en Santé Publique, Rennes, France.,DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna-Karin Edstedt-Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia.,University of Tartu, Tartu, Estonia
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Eva Cloet
- Public Health, Vrije Universiteit Brussel Faculteit Geneeskunde en Farmacie, Brussels, Belgium.,Paediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France
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Bonnet C, Blondel B, Piedvache A, Wilson E, Bonamy AKE, Gortner L, Rodrigues C, van Heijst A, Draper ES, Cuttini M, Zeitlin J. Low breastfeeding continuation to 6 months for very preterm infants: A European multiregional cohort study. MATERNAL AND CHILD NUTRITION 2018; 15:e12657. [PMID: 30136374 DOI: 10.1111/mcn.12657] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022]
Abstract
Breastfeeding confers multiple benefits for the health and development of very preterm infants, but there is scarce information on the duration of breastfeeding after discharge from the neonatal intensive care unit (NICU). We used data from the Effective Perinatal Intensive Care in Europe population-based cohort of births below 32 weeks of gestation in 11 European countries in 2011-2012 to investigate breastfeeding continuation until 6 months. Clinical and sociodemographic characteristics were collected from obstetric and neonatal medical records as well as parental questionnaires at 2 years of corrected age. Among 3,217 ever-breastfed infants, 34% were breastfeeding at 6 months of age (range across countries from 25% to 56%); younger and less educated mothers were more likely to stop before 6 months (adjusted relative risk [aRR] <25 years: 0.68, 95% CI [0.53, 0.88], vs. 25-34 years; lower secondary: 0.58, 95% CI [0.45, 0.76] vs. postgraduate education). Multiple birth, bronchopulmonary dysplasia (BPD), and several neonatal transfers reduced the probability of continuation but not low gestational age, fetal growth restriction, congenital anomalies, or severe neonatal morbidities. Among infants breastfeeding at discharge, mixed versus exclusive breast milk feeding at discharge was associated with stopping before 6 months: aRR = 0.60, 95% CI [0.48, 0.74]. Low breastfeeding continuation rates in this high-risk population call for more support to breastfeeding mothers during and after the neonatal hospitalization, especially for families with low socio-economic status, multiples, and infants with BPD. Promotion of exclusive breastfeeding in the NICU may constitute a lever for improving breastfeeding continuation after discharge.
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Affiliation(s)
- Camille Bonnet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | - Aurélie Piedvache
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | - Emilija Wilson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ludwig Gortner
- Department of Neonatology, Pediatric Center, Justus Liebig University Giessen, Giessen, Germany
| | - Carina Rodrigues
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
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